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Summary

The region has made considerable progress implementing
schemes aimed at expanding universal health coverage in the past
quarter-century. Measureable improvements in equity have been identified during
the same period. Socioeconomic gradients are clearly present in health status,
with the poor having worse observed health outcomes than the rich, but
disparities have narrowed, particularly for early stages of the life course.
Countries have reached high levels of coverage for maternal and child health services
but, despite narrowing inequality, services remain pro-rich. Coverage of noncommunicable
disease interventions is not as high as maternal and child health services and
service utilization is skewed toward the better off, though these disparities
continue to narrow as well. Primary care services are in general more equally
distributed across income groups than is specialized care. Prevalence of
noncommunicable diseases has not declined as expected given drops in mortality
across these groups. Greater access to services, and hence diagnosis, among
wealthier individuals may be masking differences in actual prevalence between
income groups. Catastrophic health expenditures have declined in most
countries, though the picture regarding equity is mixed due to measurement
limitations.

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